Healthcare Provider Details

I. General information

NPI: 1780961870
Provider Name (Legal Business Name): JULIANN SPINA BSE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/03/2011
Last Update Date: 11/03/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11115 NEW HALLS FERRY RD SUITE 301
FLORISSANT MO
63033-7613
US

IV. Provider business mailing address

2265 PARKTON WAY
BARNHART MO
63012-1269
US

V. Phone/Fax

Practice location:
  • Phone: 314-921-6200
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License Number0313472
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: